I have a 1,050- to 1,225-word paper to write for NSG/416 THEORETICAL DEVELOPMENT AND CONCEPTUAL FRAMEWORKS

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Knowing in Practice

Jean Watson's influence on nursing practice is significant. As all theorists do, she has a perspective through which she views nursing care and practice. This activity will help frame the guiding principles of University of Phoenix curriculum through the application of theory-based thinking.

Describe the five patterns of knowledge and how they can be applied in nursing practice.

Summarize the main points of Jean Watson's theory of human caring, including the 10 carative factors.

Determine how Jean Watson views the following patterns of knowledge:

• Empirical knowledge (the science)

• Esthetic knowledge (the art)

• Ethical knowing (what constitutes good actions for that patient)

• Personal knowing (nurse-patient relationship)

Explain which pattern(s) are more evident or easier to apply in Watson's theory of human caring, citing specific examples to support your explanation.

Reflect on how you may (or do) use caring science in practice and cite a practice scenario in which you could or do apply the theory to patient care.

Cite a minimum of two sources in text and include a page or slide with APA-formatted references, depending on how you format your assignment.

Format your assignment as one of the following:

• 1,050- to 1,225-word paper

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NSG/416 - THEORETICAL DEVELOPMENT AND CONCEPTUAL FRAMEWORKS Knowing in Practice Jean Watson's influence on nursing practice is significant. As all theorists do, she has a perspective through which she views nursing care and practice. This activity will help frame the guiding principles of University of Phoenix curriculum through the application of theory-based thinking. Describe the five patterns of knowledge and how they can be applied in nursing practice. Summarize the main points of Jean Watson's theory of human caring, including the 10 carative factors. Determine how Jean Watson views the following patterns of knowledge: • • • • Empirical knowledge (the science) Esthetic knowledge (the art) Ethical knowing (what constitutes good actions for that patient) Personal knowing (nurse-patient relationship) Explain which pattern(s) are more evident or easier to apply in Watson's theory of human caring, citing specific examples to support your explanation. Reflect on how you may (or do) use caring science in practice and cite a practice scenario in which you could or do apply the theory to patient care. Cite a minimum of two sources in text and include a page or slide with APA-formatted references, depending on how you format your assignment. Format your assignment as one of the following: • 1,050- to 1,225-word paper Grading Rubric Week 2: Knowing in Practice Content: 16 points possible Points possible Described the five patterns of knowledge and how they can be applied in nursing practice 4 Summarized the main points of Jean Watson’s theory of human caring, including the 10 carative factors 4 Determined how Jean Watson views the following patterns of knowledge 3 Explained which pattern(s) are more evident or easier to apply in Watson’s theory of human caring, citing specific examples to support your explanation 3 Cited a practice scenario where caring science could or did apply 2 Format: 2 points possible Points possible Cited a minimum of two sources in APA format 1 Followed a structure that is clear and concise; submission is free of grammar and syntax errors 1 Points earned/possible /18 Points earned Comm Points earned Comm Section I Copyright © 2013. Springer Publishing Company. All rights reserved. Introduction to the Caritas and Enhancing Use Through Mindfulness Sitzman, K., & Watson, J. (2013). Caring science, mindful practice : implementing watson's human caring theory. Retrieved from http://ebookcentral.proquest.com Created from apollolib on 2018-09-27 08:03:41. Copyright © 2013. Springer Publishing Company. All rights reserved. Sitzman, K., & Watson, J. (2013). Caring science, mindful practice : implementing watson's human caring theory. Retrieved from http://ebookcentral.proquest.com Created from apollolib on 2018-09-27 08:03:41. Chapter 1 Copyright © 2013. Springer Publishing Company. All rights reserved. Use of Mindfulness to Cultivate Understanding of Watson’s Theory of Caring Sitzman, K., & Watson, J. (2013). Caring science, mindful practice : implementing watson's human caring theory. Retrieved from http://ebookcentral.proquest.com Created from apollolib on 2018-09-27 08:03:41. Copyright © 2013. Springer Publishing Company. All rights reserved. Sitzman, K., & Watson, J. (2013). Caring science, mindful practice : implementing watson's human caring theory. Retrieved from http://ebookcentral.proquest.com Created from apollolib on 2018-09-27 08:03:41. 1. Use of Mindfulness to Cultivate Understanding of Watson’s Theory of Caring Copyright © 2013. Springer Publishing Company. All rights reserved. Prelude to Watson’s Theory of Human Caring and Thich Nhat Hanh's Mindfulness Practice Nurse theorists, over time, have presented various aspects of nursing practice through many different lenses, and the notion of caring is usually included in some form, either implicitly or explicitly. Most nurses and laypeople routinely associate caring with nursing. Because of this, professional caring is often vaguely assumed rather than specifically examined and purposefully enacted. Jean Watson’s Theory of Human Caring provides a foundation to carefully examine and purposefully enact caring in nursing. As a nursing student, and then a new nurse, I found that the realities of nursing education and then professional practice sometimes blunted my ability to fully and wholistically care for myself and others. Watson’s work has been a revelation and a comfort. It provides an outlet to immerse myself in the study of caring deliberatively, productively, wholistically, and completely in nursing and in life. I have been studying, practicing, and teaching Watson’s Theory of Human Caring for 27 years, since I discovered Watson’s Nursing: Human Science and Human Care: AT ­ heory of Nursing (Watson, 1985/1988). I have shared the following quote often with nursing colleagues and nursing students because it enduringly provides the basis for my understanding of Watson’s work: “Care and love are the most universal, the most tremendous and the most mysterious of cosmic forces: they comprise the primal universal psychic energy…Caring is the essence of nursing and the most central and unifying focus for nursing practice” (Watson, 1985/1988, pp. 32–33). Students and colleagues often react with wide-eyed disbelief about my straightforward assertion that there is a need to consciously, deliberately, and viscerally care and love while practicing nursing in all its forms. I entered nursing for the opportunity to care and to love, and I will do this unashamedly. Caring for and loving myself and others permeates my professional and personal life. It is a lifestyle and a commitment. Watson’s work supports this endeavor. Why Use Mindfulness to Cultivate Understanding of Watson's Theory of Caring? In studying, practicing, and teaching Watson’s theory over the years, I have found it helpful to incorporate mindfulness practice and perspectives from Thich Nhat Hanh’s Zen Buddhist tradition (Sitzman, 2002). Nhat Hanh’s m ­ indfulness practices are not religion specific and can be cultivated within any spiritual ­ ­tradition or in the absence of spiritual tradition. Watson’s work often discusses the Sitzman, K., & Watson, J. (2013). Caring science, mindful practice : implementing watson's human caring theory. Retrieved from http://ebookcentral.proquest.com Created from apollolib on 2018-09-27 08:03:41. 5 I. Introduction to the Caritas and Enhancing Use through Mindfulness i­mportance of cultivating personal practices, including mindfulness, to ­support caring ­comportment: This model now more explicitly acknowledges that the nurse or practitioner who is working with this theory and its underlying philosophy, needs to cultivate a daily practice for self. Practices such as centering, meditation, breathwork, yoga, prayer, connections with nature and other such forms of daily contemplation [mindfulness] are essential to the theory’s authenticity and success. In other words, if one is to work from a caring healing paradigm, one must live it out in daily life. (Watson, 1997, p. 51) Internalizing and then consistently practicing caring from within and w ­ ithout are essential in cultivating deep and lasting understanding. Another nurse theorist, Newman (1997), echoes this belief: We must study the process of our relationships with clients from within, as part of the process. We are imbedded in what we study. We cannot step outside the process. The nature of reality is not ­outside ourselves … The paradigm of nursing embraces wholeness and ­pattern. It reveals a world that is moving, evolving, transforming— a process. (Newman, 1997, p. 37) Copyright © 2013. Springer Publishing Company. All rights reserved. Although Nhat Hanh’s mindfulness approach evolved from a Zen Buddhist tradition, it closely parallels both Newman’s and Watson’s work: [With mindfulness] we can appreciate the wonders of life, and, at the same time, act with firm resolve to alleviate suffering [ours and the suffering of others]. Too many people distinguish between the inner world of our mind and the world outside, but these realities are not separate. They belong to the same reality. The ideas of outside and inside are helpful in everyday life [and in nursing practice], but they can become an obstacle that prevents us from experiencing ultimate reality [similar to Watson’s notion of abiding in the highest consciousness of love]. (Nhat Hanh, 1993, p. 4) Nhat Hanh offers simple yet powerful insights and mindfulness practices that will support understanding, internalization, and meaningful translation of Watson’s theory into everyday nursing practice and everyday life. They are presented in each chapter as an accompaniment to Watson’s work, and to provide examples of how to cultivate personal practices that will support caring comportment in nursing and beyond. 6 Sitzman, K., & Watson, J. (2013). Caring science, mindful practice : implementing watson's human caring theory. Retrieved from http://ebookcentral.proquest.com Created from apollolib on 2018-09-27 08:03:41. 1. Use of Mindfulness to Cultivate Understanding of Watson’s Theory of Caring Art as an Alternative Pathway for Learning Copyright © 2013. Springer Publishing Company. All rights reserved. Watson’s theory is multilayered and complex. In addition to engaging in ­spiritual practices to deepen understanding, art provides a hands-on approach that will help clarify underlying structures of the theory, the scaffolding upon which the Caritas Processes are placed. This approach moves away from traditional wordbased learning and toward an integrated, wholistic understanding. I have used art to teach nursing theory in general, and Watson’s theory in particular, for many years with great success (Sitzman & Eichelberger, 2010). Art, as it is used within this context, is meant to be a contemplative exercise for the learner, helping to uncover underlying theoretical structures and nonverbal understandings as they emerge in the conscious mind as a result of committed study. Art activities can facilitate deep insight and mindfulness. I have found, for Watson’s theory, that pointillism, mandalas, and photography have been the most helpful approaches for stimulating growth, insight, and learning. Brief explanation of each art form and its usefulness for studying and practicing Watson’s theory follows. Pointillism is a technique in which tiny points or dots of pure color are painstakingly applied to a canvas. Georges Seurat (1859–1891) perfected this ­ ­technique and created many iconic masterworks such as A Sunday on La Grande Jatte, 1884. Source: Georges Seurat, A Sunday on La Grande Jatte, 1884, 1884–1886, Oil on canvas, 207.6 × 308 cm, Helen Birch Bartlett Memorial Collection, 1926, p. 224, The Art Institute of Chicago. Reprinted with permission from the Art Institute of Chicago. Sitzman, K., & Watson, J. (2013). Caring science, mindful practice : implementing watson's human caring theory. Retrieved from http://ebookcentral.proquest.com Created from apollolib on 2018-09-27 08:03:41. 7 I. Introduction to the Caritas and Enhancing Use through Mindfulness Viewed close up, individual dots of pure color are clearly apparent. Viewed from far away, the human eye mixes the colors and creates a vibrant, multihued image in the mind’s eye. There is unity and form [in pointillism], and at the same time there is awareness of the interplay between individual points of color and the larger composition … [pointillism images] are finite works, with specific themes and bounded visual representations. However, the many points of color within each work seem to merge with the light and color in the surrounding environment to create a feeling of boundlessness. (Sitzman & Eichelberger, 2010, p. 22) Copyright © 2013. Springer Publishing Company. All rights reserved. Pointillism can also be found in nature, for example the night sky with stars and planets, or the sand and tiny seashells that can be found on the beach. Watson’s theory is like a pointillism image. It is made up of distinct points of knowledge development that merge to form a bounded yet ultimately boundless approach to caring in nursing. In this instance, learners are invited to take the opportunity to consider distinct points in Watson’s theory, to transform them into a purely visual representation (or points of color), and then place them within the context of a wordless pointillism image. Creating pointillism images provides opportunities for contemplation, exploration, free expression, learning, and feeling the central tenets of Watson’s theory within a realm other than the traditional word-based method that may sometimes confound understanding within a tangle of words. Mandalas serve a similar purpose. Mandalas are manmade or natural forms in which there is a central focal point around which multiple elements are arranged. The structure of mandalas evokes clarity and beauty. The natural boundary provided by the arrangement 8 Sitzman, K., & Watson, J. (2013). Caring science, mindful practice : implementing watson's human caring theory. Retrieved from http://ebookcentral.proquest.com Created from apollolib on 2018-09-27 08:03:41. Copyright © 2013. Springer Publishing Company. All rights reserved. 1. Use of Mindfulness to Cultivate Understanding of Watson’s Theory of Caring of elements around the central point provides unity and offers the possibility of adding additional layers without altering the central point. Possibilities for creating mandalas are endless. I have had students who created mandalas from leaves, pine cones, paper, paint, pencils, markers, found items, trash, textiles, and edible elements. Mandalas are abundant in spiritual traditions, for example, rose windows in Christian cathedrals, sand paintings in Buddhism depicting the cycle of birth and death, tile decorations in Muslim mosques, and temple murals depicting natural cycles in the Hindu tradition. Mandalas are also abundant in nature, for example, the iris of the eye, flowers, hurricanes, spider webs, the solar system, the arrangement of branches and leaves on trees, seashells, and the human form. Envisioning caring as a central point and then arranging specific aspects of Watson’s theory around that central point will help each learner to organize understandings into unique and meaningful configurations. As learning deepens, elements may be added or rearranged until cohesive comprehension is achieved. Sitzman, K., & Watson, J. (2013). Caring science, mindful practice : implementing watson's human caring theory. Retrieved from http://ebookcentral.proquest.com Created from apollolib on 2018-09-27 08:03:41. 9 Copyright © 2013. Springer Publishing Company. All rights reserved. I. Introduction to the Caritas and Enhancing Use through Mindfulness 10 Sitzman, K., & Watson, J. (2013). Caring science, mindful practice : implementing watson's human caring theory. Retrieved from http://ebookcentral.proquest.com Created from apollolib on 2018-09-27 08:03:41. 1. Use of Mindfulness to Cultivate Understanding of Watson’s Theory of Caring Some learners might prefer to search for and document/take photographs of existing images to evoke elements related to Watson’s theory. This offers yet another approach for visual exploration and learning. How This Book Is Arranged This book is arranged to provide a simple and direct method for learning about and working with Watson’s Theory of Human Caring. Overviews of Watson’s ­theory, Nhat Hanh’s mindfulness practices and perspectives, and Layers of Caring and Mindful Influence are presented in the following three chapters. The remaining chapters will present each of Watson’s 10 Caritas Processes along with project abstracts that illustrate integration of the theory into professional practice in a variety of areas. The project abstracts describe actual projects undertaken by students in the Watson Caring Institute Caritas Coach Education Program. Mindfulness insights from Thich Nhat Hanh’s tradition will provide examples of intersections between caring science and mindfulness practice. The mindfulness examples and practices presented here are not specific to one spiritual tradition and are meant to enrich and support all spiritual traditions. Art activities will also be included for learners interested in deepening understanding through the creation of contemplative art. Simple steps are provided below for the creation of each type of art. Creating Pointillism Images Copyright © 2013. Springer Publishing Company. All rights reserved. Follow the steps listed below to create simple contemplative pointillism images (summarized from Sitzman & Eichelberger, 2011): 1. Gather art supplies that include cardstock or watercolor-weight paper, acrylic or watercolor paints, and cotton-tipped swabs. You may also use markers, crayons, or colored pencils. 2. Using a pencil, lightly outline shapes or forms on the paper to evoke the concept you are contemplating. 3. Use the cotton-tipped swabs and paint, markers, crayons, or colored pencils to dab different colors within and around the shapes outlined in Step 2. Fill each shape with two or three different colors of dots, and also fill the surrounding space with contrasting colors. 4. Look at the finished work close up. Notice how easy it is to see individual dots of color and how difficult it is to discern the shapes that were penciled in at the beginning. Watson’s Caritas Processes are made up of distinct conceptual/theoretical ideas, represented by the individual points of color in the pointillism image. Sitzman, K., & Watson, J. (2013). Caring science, mindful practice : implementing watson's human caring theory. Retrieved from http://ebookcentral.proquest.com Created from apollolib on 2018-09-27 08:03:41. 11 I. Introduction to the Caritas and Enhancing Use through Mindfulness 5. Now look at the finished work from 20 feet away. Notice how individual dots of color are difficult to distinguish, and it becomes easier to see those larger shapes that were penciled in and filled with distinct colors. When the components of Watson’s Caritas Processes blend together, a transpersonal caring moment is created. The visual blending of the dots in the pointillism image represents this phenomenon. Transpersonal caring moments will be described in more detail in the following chapter. Creating Mandala Images Copyright © 2013. Springer Publishing Company. All rights reserved. Mandalas have a central point of interest (the concept or idea that you are contemplating), surrounded by smaller components (supporting ideas related to the central concept) symmetrically arranged into a unified whole. Mandalas are purposefully arranged to evoke clarity, beauty, and nonverbal understanding. They have boundaries to provide a sense of unity and completeness; however, the symmetry of mandala designs easily allows for the inclusion of additional layers as ideas and understandings develop. To cultivate understanding and insight, it is important to experience the creation (or completion through coloring) of mandalas. Follow the steps listed below to create simple contemplative mandala images (summarized from Sitzman & Eichelberger, 2011): 1. Assemble whatever tools you prefer to color with: crayons, markers, paint, colored pencils, or colored bits of paper. 2. Go to a mandala website (there are numerous websites with free mandalas available to print), purchase a mandala coloring book, or draw your own mandala to color. Choose a design that resonates with your feelings about the concept(s) you are contemplating. 3. Add colors to the mandala that express your feelings and understandings about the contemplative concept. 4. It is also possible to create mandalas with found objects from trash, nature, or everyday household objects. Choose the method that is most interesting to you. Creating Photographic Images Use a camera of any type to create photographic images that represent Watson’s work. Pointillism can be photographed because it is evident in the weave of textiles, the skins of lizards and frogs, patterns of fading and wear on articles of clothing, television screen images, the inside of pomegranates, leaves in a forest 12 Sitzman, K., & Watson, J. (2013). Caring science, mindful practice : implementing watson's human caring theory. Retrieved from http://ebookcentral.proquest.com Created from apollolib on 2018-09-27 08:03:41. 1. Use of Mindfulness to Cultivate Understanding of Watson’s Theory of Caring landscape, sand on the beach, wood grains, ceramic textures, cross-stitch pictures, and fields of grass and wildflowers. Mandalas are abundant in urban and natural surroundings. Mindfully observing the contents of a living room, components of a neighborhood park, the façades of churches, or the toys in a preschool classroom, for example, will provide many mandala forms to photograph. Other examples of mandala forms to photograph include flowers, cross-sections of oranges or other fruits and vegetables, ripples in ponds, stars, constellations, seashells, crystals, and pine cones. Write contextual descriptions of the photographs you create that clarify relationships to Watson’s work. References Copyright © 2013. Springer Publishing Company. All rights reserved. Newman, M. A. (1997). Experiencing the whole. Advanced Nursing Science, 20(1), 34–39. Nhat Hanh, T. (1993). Interbeing: Fourteen guidelines for engaged Buddhism. Berkeley, CA: Parallax Press. Sitzman, K. (2002). Interbeing and mindfulness: A bridge to u ­ nderstanding Jean Watson’s Theory of Human Caring. Nursing Education Perspectives, 23(3), 118–123. Sitzman, K., & Eichelberger, L. (2011). Understanding the work of nurse theorists: A creative beginning. Sudbury, MA: Jones & Bartlett. Watson, J. (1988). Nursing: Human science and human care. New York, NY: National League for Nursing. (Original work published 1985) Watson, J. (1997). The theory of human caring: Retrospective and prospective. Nursing Science Quarterly, 10(1), 49–52. Sitzman, K., & Watson, J. (2013). Caring science, mindful practice : implementing watson's human caring theory. Retrieved from http://ebookcentral.proquest.com Created from apollolib on 2018-09-27 08:03:41. 13 Copyright © 2013. Springer Publishing Company. All rights reserved. Sitzman, K., & Watson, J. (2013). Caring science, mindful practice : implementing watson's human caring theory. Retrieved from http://ebookcentral.proquest.com Created from apollolib on 2018-09-27 08:03:41. Chapter 2 Copyright © 2013. Springer Publishing Company. All rights reserved. Overview of Watson’s Theory (10 Caritas) Sitzman, K., & Watson, J. (2013). Caring science, mindful practice : implementing watson's human caring theory. Retrieved from http://ebookcentral.proquest.com Created from apollolib on 2018-09-27 08:03:41. Copyright © 2013. Springer Publishing Company. All rights reserved. Sitzman, K., & Watson, J. (2013). Caring science, mindful practice : implementing watson's human caring theory. Retrieved from http://ebookcentral.proquest.com Created from apollolib on 2018-09-27 08:03:41. 2. Overview of Watson’s Theory (10 Caritas) Copyright © 2013. Springer Publishing Company. All rights reserved. Introduction to Jean Watson Jean Watson, PhD, RN, AHN-BC, FAAN, distinguished professor and dean ­emerita at the University of Colorado, Denver College of Nursing and Anschutz Medical Center, held an endowed chair in caring science for 16 years. She is founder of the original Center for Human Caring in Colorado and is a Fellow of the American Academy of Nursing. She previously served as dean of nursing at the University Health Sciences Center and is a past president of the National League for Nursing. Dr. Watson earned undergraduate and graduate degrees in nursing and ­psychiatric-mental health nursing and holds her PhD in educational ­psychology and counseling. She is a widely published author and recipient of many awards and honors, including the Fetzer Institute Norman Cousins Award, in r­ ecognition of her commitment to developing, maintaining, and exemplifying r­ elationship-centered care practices; an international Kellogg Fellowship in ­Australia; and a Fulbright Research Award in Sweden. She holds 10 honorary doctoral degrees, i­ncluding seven international honorary doctorates ­ (Sweden; United Kingdom; Spain; British Columbia and Quebec, Canada; and Japan). Dr. Watson’s caring philosophy is used to guide transformative models of caring and healing practices for nurses, allied health professionals, caregivers, and patients in diverse settings worldwide. These settings include institutions for higher education, centers for education and learning, hospitals, clinics, and public agencies. At the University of Colorado, Dr. Watson held the title of distinguished professor of nursing—the highest honor accorded its faculty for scholarly work. In 1999 she assumed the Murchinson-Scoville chair in caring science, the nation’s first endowed chair in caring science, based at the University of Colorado Denver and Anschutz Medical Center. As author or coauthor of over 18 books on caring, her latest books range from empirical measurements and international research on caring, to new postmodern philosophies of caring and healing, philosophy, and science of caring, and caring science as sacred science. Her work bridges related paradigms and points toward transformative models of caring for the 21st century. Many of her books have been honored with the American Journal of Nursing Book of the Year award. Transpersonal Caring—Caring Science Transpersonal caring relationships are the foundation of Watson’s work. Transpersonal caring occurs when the one caring connects with and embraces the spirit of the other through authentic, full attention in the here and now, and conveys a ­concern for the inner life and personal meaning of another. Transpersonal caring also seeks Sitzman, K., & Watson, J. (2013). Caring science, mindful practice : implementing watson's human caring theory. Retrieved from http://ebookcentral.proquest.com Created from apollolib on 2018-09-27 08:03:41. 17 Copyright © 2013. Springer Publishing Company. All rights reserved. I. Introduction to the Caritas and Enhancing Use through Mindfulness to go beyond the self and beyond the here and now, reaching to deeper connections with spirit, and with the broader universal consciousness. Transpersonal caring relationships start with full attention in the moment, and then radiate to spiritual, limitless connections that tap into subtle healing possibilities and potentials. The degree to which a nurse is able to detect a person’s condition of being from the gross physical to the soul/spirit level is influenced by the nurse’s cultivation of conscious love and caring intentions related to the nurse as she or he enters into the life space/phenomenal field of another. Focus on the uniqueness of self and other and the uniqueness of the moment, wherein the coming together is mutual and reciprocal, each fully embodied in the moment, while paradoxically capable of transcending the moment, exemplifies the transpersonal caring relationship. The emergence of new possibilities is also a hallmark. Transpersonal caring calls for authenticity and an ability to be present to self and other in a reflective frame; the transpersonal nurse has the ability to center consciousness and intentionality on caring, healing, and wholeness, rather than on disease, illness, and pathology. An ability to be fully in the present moment, while at the same time embracing the transformative process of becoming, emerges from an awareness of impermanence and the constant metamorphic influence of ­interconnectedness. In other words, the nurse attempts to enter into and stay within the other’s frame of reference, attempting to connect with the inner life world of meaning and spirit of the other. Together, they join in a mutual search for meaning and wholeness of being/becoming to potentiate comfort measures, pain control, a sense of well-being, wholeness, and even spiritual transcendence of suffering. Every person is viewed as whole and complete, regardless of illness or disease (Watson, 1996, Blueprint: p. 153). Transpersonal caring competencies are related to cultivation of the nurse’s human competencies and ways of being/becoming (ontology). In Watson’s model, these caring competencies are as critical as technological ­curing competencies. This approach is a departure from the conventional, modern, W ­ estern ­nursing–­medicine model where technological curing competencies tend to be considered c­ritical, whereas transpersonal caring competencies tend to be considered ­helpful but not critical. Within Watson’s Model of Transpersonal ­Caring, ­introductory work with clinical Caritas is facilitated to create a foundation for ongoing c­ ultivation of transpersonal caring competencies, in addition to the acquisition of technological curing competencies. Application of transpersonal caring competencies occurs during caring moments or caring occasions, which are described in the following. Caring Moments, Caring Occasions A caring occasion occurs whenever the nurse and another come together with their unique life histories and phenomenal fields, creating a distinct caring moment in space and time. This moment moves toward transcending space and 18 Sitzman, K., & Watson, J. (2013). Caring science, mindful practice : implementing watson's human caring theory. Retrieved from http://ebookcentral.proquest.com Created from apollolib on 2018-09-27 08:03:41. 2. Overview of Watson’s Theory (10 Caritas) time as the actual caring occasion becomes a pebble that ripples in the ­cosmic pond, becoming part of the life history of each participant, then affecting self and others in widening circles of proximity, rippling outward in all ­directions to become part of the complex web of life, time, space, and spirit (Watson, 1985/1988). A caring moment involves an action and choice by both the nurse and the other. The moment of coming together presents an opportunity to decide how to be in the moment and in the relationship and opens opportunities for choosing how to engage in the moment. If the caring moment is transpersonal, each feels a connection with the other at the spirit level, thus it transcends time and space, opening up new possibilities for healing and human connection at a deeper level than physical interaction: “… we learn from one another how to be human by identifying ourselves with others, finding their dilemmas in ourselves. What we all learn from it is self-knowledge. The self we learn about … is every self. It is universal—the human self. We learn to recognize ourselves in others … (it) keeps alive our common humanity and avoids reducing self or other to the moral status of object” (Watson, 1985/1988, pp. 59–60). Copyright © 2013. Springer Publishing Company. All rights reserved. Caring (Healing) Consciousness The dynamic of transpersonal caring (healing) within a caring moment exists in the field of consciousness. The transpersonal dimensions of a caring moment are affected by the nurse’s consciousness in the caring moment, which in turn affects the field of the whole. Evolving consciousness within the individual comes to acknowledge love as the highest consciousness. Consciousness as it relates to transpersonal caring is further described by the following (Watson, 1996, p. 148): • Caring–healing–loving consciousness is contained within a single caring moment. • The one caring and the one being cared for are interconnected; the caring–healing process is connected with the other human(s) and the higher energy of the universe; the caring–healing–loving consciousness of the nurse is communicated to the one being cared for; caring–healing–loving consciousness exists through and transcends time and space and can be dominant over physical dimensions. • Within this context, it is acknowledged that the process is relational and connected; it transcends time, space, and physicality. The process is intersubjective with transcendent possibilities that go beyond the given caring moment. Sitzman, K., & Watson, J. (2013). Caring science, mindful practice : implementing watson's human caring theory. Retrieved from http://ebookcentral.proquest.com Created from apollolib on 2018-09-27 08:03:41. 19 I. Introduction to the Caritas and Enhancing Use through Mindfulness Caring Science Defined Caring science encompasses a humanitarian, human science orientation to human caring processes, phenomena, and experiences. Caring science includes arts and humanities as well as science. Caring science perspective acknowledges interconnectedness as the foundation of all caring interactions and activities. Transpersonal caring acknowledges unity of life and connections that move in concentric circles of caring—from individual, to others, to community, to world, to Planet Earth, to the universe, and beyond. The Implications of Caring Theory Copyright © 2013. Springer Publishing Company. All rights reserved. The caring model or theory can also be considered a philosophical and moral/­ ethical foundation for professional nursing and part of the central focus for ­nursing at the disciplinary level. A model of caring includes a call for both art and s­ cience; it offers a framework that embraces and intersects with art, ­science, ­humanities, spirituality, and new dimensions of mindbodyspirit medicine and nursing evolving openly as central to human phenomena of nursing practice. Watson emphasizes that it is possible to read, study, learn about, even teach and research the caring theory; however, to truly “get it,” one has to personally ­experience it; thus the model is both an invitation and an opportunity to interact with the ideas, experiment with and grow within the philosophy, and live it in one’s personal/ professional life (Watson, 1999). The Future of Nursing The future of nursing depends upon whether or not it matures into a distinct health, healing, and caring profession that it has always represented across time, but has yet to actualize. Nursing, thus ironically, now is challenged to stand and mature within its own paradigm, while simultaneously having to transcend it and share with others. The future already reveals that all health care ­practitioners will need to work within a shared framework of caring relationships, ­mindbodyspirit medicine, embracing healing arts, caring practices, and processes, and the spiritual dimensions of care much more completely. Thus, nursing is at its own crossroad of possibilities, among worldviews, paradigms, centuries, and eras; invited and required to build upon its heritage and latest evolution in science and t­ echnology. The nursing profession must transcend its own boundaries for a postmodern 20 Sitzman, K., & Watson, J. (2013). Caring science, mindful practice : implementing watson's human caring theory. Retrieved from http://ebookcentral.proquest.com Created from apollolib on 2018-09-27 08:03:41. 2. Overview of Watson’s Theory (10 Caritas) future yet to be known. H ­ owever, ­nursing’s future holds promises of caring and healing mysteries and models yet to unfold as opportunities for offering compassionate Caritas service await at i­ndividual, system, societal, national, and global levels for self, profession, and the broader world community. Nurses with informed Caritas Consciousness could literally t­ ransform entire systems, contributing to worldwide changes through their own practices of Being, thus “seeing” and doing things differently—­holding a different consciousness, radiating different messages, a­ ffecting the subtle energetic environment, spreading healing, wholeness, ­forgiveness, beauty, love, kindness, equanimity. In this awareness, nurses are literally becoming the Caritas field. (Watson, 2008, p. 59) 10 Caritas Processes Copyright © 2013. Springer Publishing Company. All rights reserved. The word “Caritas” is Latin. It means to cherish, appreciate, and give special or loving attention with charity, compassion, and generosity of spirit. Caritas is very fine and precious, and must be actively cultivated to be sustained (Watson, 2008). Over the years, Watson has developed and refined 10 Caritas Processes to guide nurses and others in applying her theoretical constructs, and cultivating caring moments and caring occasions in their own professional practices. They may also be used to form philosophical and professional practice foundations at broader levels in clinical and academic settings. The list of 10 Caritas Processes presented here will form the basis of study for the remainder of this book. They will be addressed in more detail in subsequent chapters: 1. Sustaining humanistic–altruistic values by practice of loving kindness, compassion, and equanimity with self/others. 2. Being authentically present, enabling faith/hope/belief system; honoring subjective inner, life-world of self/others. 3. Being sensitive to self and others by cultivating own spiritual practices; beyond ego-self to transpersonal presence. 4. Developing and sustaining loving, trusting–caring relationships. 5. Allowing for expression of positive and negative feelings— authentically listening to another person’s story. Sitzman, K., & Watson, J. (2013). Caring science, mindful practice : implementing watson's human caring theory. Retrieved from http://ebookcentral.proquest.com Created from apollolib on 2018-09-27 08:03:41. 21 I. Introduction to the Caritas and Enhancing Use through Mindfulness 6. Creatively problem-solving-“solution-seeking” through caring process; full use of self and artistry of caring–healing practices via use of all ways of knowing/being/doing/becoming. 7. Engaging in transpersonal teaching and learning within context of caring relationship; staying within other’s frame of reference—shift toward coaching model for expanded health/wellness. 8. Creating a healing environment at all levels; subtle environment for energetic authentic caring presence. 9. Reverentially assisting with basic needs as sacred acts, touching mindbodyspirit of other; sustaining human dignity. 10. Opening to spiritual, mystery, unknowns—allowing for miracles (WatsonCaringScience.org) References Copyright © 2013. Springer Publishing Company. All rights reserved. Watson, J. (1985/1988). Nursing: Human science and human care. New York, NY: National League for Nursing Press. Watson, J. (1996). Watson’s theory of transpersonal caring. In P. H. Walker & B. Neuman (Eds.), Blueprint for use of nursing models: Education, research, ­practice, & administration (pp. 141–184). New York, NY: National League for Nursing Press. Watson, J. (1999). Nursing: Human science and human care: A theory of nursing. New York, NY: National League for Nursing Press. Watson, J. (2008). Nursing: The philosophy and science of caring (Rev. ed.). B ­ oulder, CO: University Press of Colorado. 22 Sitzman, K., & Watson, J. (2013). Caring science, mindful practice : implementing watson's human caring theory. Retrieved from http://ebookcentral.proquest.com Created from apollolib on 2018-09-27 08:03:41. Chapter 3 Copyright © 2013. Springer Publishing Company. All rights reserved. Thich Nhat Hanh’s Five Mindfulness Trainings Sitzman, K., & Watson, J. (2013). Caring science, mindful practice : implementing watson's human caring theory. Retrieved from http://ebookcentral.proquest.com Created from apollolib on 2018-09-27 08:03:41. Copyright © 2013. Springer Publishing Company. All rights reserved. Sitzman, K., & Watson, J. (2013). Caring science, mindful practice : implementing watson's human caring theory. Retrieved from http://ebookcentral.proquest.com Created from apollolib on 2018-09-27 08:03:41. 3. Thich Nhat Hanh’s FIVE Mindfulness Trainings Introduction to Thich Nhat Hanh Thich Nhat Hanh is a well-known and respected Zen master. He was born in Vietnam in 1926 and began the process of becoming a monk at the age of 16. During the Vietnam War, Nhat Hanh continued his mindful and meditative life, and also chose to assist villagers suffering from the devastations of the war. In this way, Nhat Hanh helped to start the “engaged Buddhism” movement. He continues to teach mindfulness for inner transformation, meant to benefit individuals, families, groups, communities, society, the world, and beyond. After visiting the United States and Europe in 1966 on a peace mission, he was banned from returning to Vietnam. In 1982, Nhat Hanh founded Plum Village, a Buddhist community in France that still flourishes today. Along with other monks, nuns, and laypeople within Nhat Hanh’s mindfulness tradition, he continues to teach mindfulness practices to thousands of people all over the world each year, and also continues his work to alleviate hunger, and help refugees, boat people, and political prisoners in Vietnam and throughout the Third World. He has published widely on topics related to mindfulness and engaged Buddhism (www.plumvillage.org/thich-nhat-hanh.html). Copyright © 2013. Springer Publishing Company. All rights reserved. Brief Overview of Mindfulness Practice “Mindfulness is the energy of being aware and awake to the present moment. It is the continuous practice of touching life deeply in every moment of daily life. To be mindful is to be truly alive, present and at one with those around you and with what you are doing. We bring our body and mind into harmony while we wash the dishes, drive the car or take our morning shower” (www.plumvillage. org/thich-nhat-hanh.html). Mindfulness is about letting go of doctrines and simply being fully present in each moment of life. Ideas about caring, understanding, and compassion are not understanding and compassion. Caring, understanding, and compassion must be seen and touched through the immediacy of mindfulness practice (Nhat Hanh, 1993). This is a simple yet profound practice with the power to cultivate deep caring and understanding. Truly dwelling in each moment sounds simple to do, yet it is a challenging endeavor because we are conditioned to park our physical body in the present, and then engage our minds and hearts in the contemplation of mental formations, that is, thoughts, feelings, past events or future plans, and worries. In doing this, we lose touch with what is happening around us in the present moment. Mindfulness practice is meant to help unify mind, body, heart, and spirit with what is happening right now rather than what has been or what may be. In doing this, we become fully available to see, understand, love, care, and enter the stream of what Watson describes as the transpersonal caring moment. There is no time-defined path of caring, love, and mindfulness; Sitzman, K., & Watson, J. (2013). Caring science, mindful practice : implementing watson's human caring theory. Retrieved from http://ebookcentral.proquest.com Created from apollolib on 2018-09-27 08:03:41. 25 I. Introduction to the Caritas and Enhancing Use through Mindfulness caring, love, and mindfulness is the path that manifests from the moment we fully attend to the present with the understanding that we are profoundly interconnected with all that precedes and surrounds us. Nhat Hanh describes feelings and mental formations as impermanent, passing by in the sky of our mind like white clouds on a sky-blue background. It is impossible to cling to clouds and keep them from passing by; so it is the same for feelings and thoughts. Mindfulness involves compassionately acknowledging the clouds that pass by the sky of our mind and letting go of the notion that we must retain them. Letting go of the clouds, which one could never cling to in the first place, allows full awareness of the present and all it contains. In practical terms, the [human being, situation] before you becomes part of the present moment, and in this way, mindfulness creates connection and intimacy in that moment … thereby deepening the mutuality of human-to-human caring and enabling the transpersonal caring moment (Sitzman, 2002, p. 123) Copyright © 2013. Springer Publishing Company. All rights reserved. Mindfulness must be cultivated through conscious, deliberate, ongoing practice. The foundational practice in Nhat Hanh’s tradition is gentle, nonjudgmental attention to the breath. The breath is the thread that knits the physical/thinking dimension into the fabric of the heart/spiritual dimension. The simple act of continually bringing attention back to one’s own in-breath and out-breath serves to unify mindbodyspirit heart in the present moment. Here is a simple practice in Nhat Hanh’s tradition to bring attention to the breath: As you breathe in, you say to yourself “Breathing in, I know that I am breathing in.” And as you breathe out, say “Breathing out, I know that I am breathing out.” Just that. You recognize your in-breath as an in-breath and your out-breath as an out-breath. You don't even need to recite the whole sentence; you can use just two words: “In” and “Out.” This technique can help you keep your mind on your breath. As you practice, your breath will become peaceful and ­gentle, and your mind will also become peaceful and gentle. This is not a difficult exercise. In just a few minutes you can realize the fruit of meditation. Breathing in and out is very important, and it is enjoyable. Our ­breathing is the link between our body and mind. Sometimes our mind is thinking of one thing and our body is doing another, and the mind and body are not unified. By concentrating on our breathing, “In” and “Out,” we bring body and mind back together, and become whole again. Conscious breathing is an important bridge … when we breathe consciously we recover ourselves completely and encounter life in the present moment. (Nhat Hanh, 1991, pp. 8–9) The only way to understand mindfulness is to practice it. In its simplicity, it can be understood and utilized in varied environments and by many different 26 Sitzman, K., & Watson, J. (2013). Caring science, mindful practice : implementing watson's human caring theory. Retrieved from http://ebookcentral.proquest.com Created from apollolib on 2018-09-27 08:03:41. 3. Thich Nhat Hanh’s FIVE Mindfulness Trainings Copyright © 2013. Springer Publishing Company. All rights reserved. personalities. Mindfulness can be immediately integrated into any area of nursing practice—it is as close as one deliberately observed breath. In addition to following and observing the breath, awareness of the interconnectivity of self with others is essential in both Nhat Hanh’s mindfulness tradition and Watson’s transpersonal caring. Nhat Hanh refers to this state of awareness as interbeing. Nhat Hanh and Watson both assert that everything ­influences and is inexorably connected to everything else. Nhat Hanh provides an illustrative example; that the whole of the universe can be found within a single sheet of paper: … there is a cloud floating in this sheet of paper. Without a cloud, there will be no rain; without rain, the trees cannot grow; and without trees, we cannot make paper. The cloud is essential for the paper to exist. If the cloud is not here, the sheet of paper cannot be here either. So we can say that the cloud and the paper inter-are. “Interbeing” is a word that is not in the dictionary yet, but if we combine the prefix “inter-” with the verb “to be,” we have a new verb, inter-be. If we look into this sheet of paper even more deeply, we can see the sunshine in it. Without sunshine, the forest cannot grow. In fact, nothing can grow without sunshine, and so, we know that the ­sunshine is also in this sheet of paper. The paper and the sunshine inter-are. And if we continue to look, we can see the logger who cut the tree and brought it to the mill to be transformed into paper. And we see wheat. We know that the logger cannot exist without his daily bread, and therefore the wheat that became his daily bread is also in this sheet of paper. The logger’s father and mother are in it too. When we look in this way, we see that without all of these things, this sheet of paper cannot exist … We cannot point out one thing that is not in here [this sheet of paper]—time, space, the earth, the rain, the minerals in the soil, the sunshine, the cloud, the river, the heat. Everything co-exists with this sheet of paper … As thin as this sheet of paper is, it contains everything in the universe in it. (Nhat Hanh, 1991, pp. 95–96) Nhat Hanh created five mindfulness trainings to support the cultivation of an enduring mindfulness practice and support awareness of interbeing. They are listed below (Nhat Hanh, 2007, pp. 14–15): 1. Reverence for Life Aware of the suffering caused by the destruction of life, I am committed to cultivating the insight of interbeing and compassion and learning ways to protect the lives of people, animals, plants, and minerals. I am determined not to kill, not to let others kill, and not to support any act of killing in the world, in my thinking, or in my way of life. Seeing that harmful Sitzman, K., & Watson, J. (2013). Caring science, mindful practice : implementing watson's human caring theory. Retrieved from http://ebookcentral.proquest.com Created from apollolib on 2018-09-27 08:03:41. 27 I. Introduction to the Caritas and Enhancing Use through Mindfulness Copyright © 2013. Springer Publishing Company. All rights reserved. actions arise from anger, fear, greed, and intolerance, which in turn come from dualistic and discriminative thinking, I will cultivate openness, nondiscrimination, and nonattachment to views in order to transform violence, fanaticism, and dogmatism in myself and in the world. 2. True Happiness Aware of the suffering caused by exploitation, social injustice, stealing, and oppression, I am committed to practicing generosity in my thinking, speaking, and acting. I am determined not to steal and not to possess anything that should belong to others; and I will share my time, energy, and material resources with those who are in need. I will practice looking deeply to see that the happiness and suffering of others are not separate from my own happiness and suffering; that true happiness is not possible without understanding and compassion; and that running after wealth, fame, power, and sensual pleasures can bring much suffering and despair. I am aware that happiness depends on my mental attitude and not on external conditions, and that I can live happily in the present moment simply by remembering that I already have more than enough conditions to be happy. I am committed to practicing Right Livelihood so that I can help reduce the suffering of living beings on Earth and reverse the process of global warming. 3. True Love Aware of the suffering caused by sexual misconduct, I am committed to cultivating responsibility and learning ways to protect the safety and integrity of individuals, couples, families, and society. Knowing that sexual desire is not love, and that sexual activity motivated by craving always harms myself as well as others, I am determined not to engage in sexual relations without true love and a deep, longterm commitment made known to my family and friends. I will do everything in my power to protect children from sexual abuse and to prevent couples and families from being broken by sexual misconduct. Seeing that body and mind are one, I am committed to learning appropriate ways to take care of my sexual energy and cultivating loving kindness, compassion, joy, and inclusiveness—which are the four basic elements of true love—for my greater happiness and the greater happiness of others. Practicing true love, we know that we will continue beautifully into the future. 4. Loving Speech and Deep Listening Aware of the suffering caused by unmindful speech and the inability to listen to others, I am committed to cultivating loving speech and compassionate listening in order to relieve suffering and to promote reconciliation and peace in myself and among other people, ethnic and religious groups, and nations. Knowing that words can create 28 Sitzman, K., & Watson, J. (2013). Caring science, mindful practice : implementing watson's human caring theory. Retrieved from http://ebookcentral.proquest.com Created from apollolib on 2018-09-27 08:03:41. Copyright © 2013. Springer Publishing Company. All rights reserved. 3. Thich Nhat Hanh’s FIVE Mindfulness Trainings happiness or suffering, I am committed to speaking truthfully and using words that inspire confidence, joy, and hope. When anger is manifesting in me, I am determined not to speak. I will practice mindful breathing and walking in order to recognize and to look deeply into my anger. I know that the roots of anger can be found in my wrong perceptions and lack of understanding of the suffering in myself and in the other person. I will speak and listen in a way that can help myself and the other person to transform suffering and see the way out of difficult situations. I am determined not to spread news that I do not know to be certain and not to utter words that can cause division or discord. I will practice Right Diligence to nourish my capacity for understanding, love, joy, and inclusiveness, and gradually transform anger, violence, and fear that lie deep in my consciousness. 5. Nourishment and Healing Aware of the suffering caused by unmindful consumption, I am committed to cultivating good health, both physical and mental, for myself, my family, and my society by practicing mindful eating, drinking, and consuming. I will practice looking deeply into how I consume the four kinds of nutriments, namely edible foods, sense impressions, volition, and consciousness. I am determined not to gamble, or to use alcohol, drugs, or any other products which contain toxins, such as certain websites, electronic games, TV programs, films, magazines, books, and conversations. I will practice coming back to the present moment to be in touch with the refreshing, healing, and nourishing elements in me and around me, not letting regrets and sorrow drag me back into the past nor letting anxieties, fear, or craving pull me out of the present moment. I am determined not to try to cover up loneliness, anxiety, or other suffering by losing myself in consumption. I will contemplate interbeing and consume in a way that preserves peace, joy, and well-being in my body and consciousness, and in the collective body and consciousness of my family, my society, and the Earth. Integrating mindfulness trainings in the tradition of Thich Nhat Hanh with the study of Watson’s work supports an interdisciplinary approach to understanding and enacting Watson’s transpersonal caring moments within varied professional nursing environments. These environments include, but are not limited to, hospitals, long-term care, hospice, home health care, community/public health, occupational health, nursing education, professional nursing organizations, and nursing research. They are especially relevant and helpful for us as caring professionals and our daily practices and relationships with self, family, colleagues, and friends. Sitzman, K., & Watson, J. (2013). Caring science, mindful practice : implementing watson's human caring theory. Retrieved from http://ebookcentral.proquest.com Created from apollolib on 2018-09-27 08:03:41. 29 I. Introduction to the Caritas and Enhancing Use through Mindfulness References Copyright © 2013. Springer Publishing Company. All rights reserved. Nhat Hanh, T. (1991). Peace is every step: The path of mindfulness in everyday life. New York, NY: Bantam Books. Nhat Hanh, T. (1993). Interbeing: Fourteen guidelines for engaged Buddhism. Berkeley, CA: Parallax Press. Nhat Hanh, T. (2007). For a future to be possible. Berkeley, CA: Parallax Press. Sitzman, K. (2002). Interbeing and mindfulness: A bridge to understanding Jean Watson’s Theory of Human Caring. Nursing Education Perspectives, 23(3), 118–123. 30 Sitzman, K., & Watson, J. (2013). Caring science, mindful practice : implementing watson's human caring theory. Retrieved from http://ebookcentral.proquest.com Created from apollolib on 2018-09-27 08:03:41. Chapter 4 Copyright © 2013. Springer Publishing Company. All rights reserved. Entering the Stream: Understanding and Living Out Jean Watson’s Work Sitzman, K., & Watson, J. (2013). Caring science, mindful practice : implementing watson's human caring theory. Retrieved from http://ebookcentral.proquest.com Created from apollolib on 2018-09-27 08:03:41. Copyright © 2013. Springer Publishing Company. All rights reserved. Sitzman, K., & Watson, J. (2013). Caring science, mindful practice : implementing watson's human caring theory. Retrieved from http://ebookcentral.proquest.com Created from apollolib on 2018-09-27 08:03:41. 4. Entering the Stream: Understanding and Living Out Jean Watson’s Work Layers of Caring and Mindful Influence: Pebbles in a Pond Model Copyright © 2013. Springer Publishing Company. All rights reserved. Watson’s emphasis on philosophical concepts can be translated into everyday nursing practice by acknowledging specific layers of caring and mindful influence. Envision a still blue pond, reflecting surrounding images of trees, blue sky, clouds, and mountains. This pond is the ground of being for everyday life. Imagine a person (or nurse), with the intention to care, as a pebble dropped into the pond. Caring influence from this one small pebble ripples outward from wherever it was initially dropped. Self, others, peers, leaders, local/world communities, the environment, virtual/web-based, and beyond are all eventually touched as ever-widening, holographic spheres of influence move outward from wherever the pebble was initially dropped. One caring intention and/or action affects the universe, transcending time/space/physical boundaries, similar to Nhat Hanh’s universe in a single sheet of paper described in Chapter 3. This is the essence of each transpersonal caring moment grounded in mindfulness. See Figure 4.1 for a simple visual representation: Self Others Peers Leaders Local/world communities The environment Virtual/web based Beyond... Figure 4.1 Pebble in a pond model. Sitzman, K., & Watson, J. (2013). Caring science, mindful practice : implementing watson's human caring theory. Retrieved from http://ebookcentral.proquest.com Created from apollolib on 2018-09-27 08:03:41. 33 I. Introduction to the Caritas and Enhancing Use through Mindfulness Transpersonal caring consists of a stream of transpersonal caring moments that radiate in all directions beyond the specific moment, through space, time, and the physical plane, to create endless possibilities of caring influence. Entering the stream, or dropping a pebble in the pond at any point, will enact caring influence in every other area. Nurses in all areas of practice have endless opportunities to care, to enter the stream of mindful caring influence. “The human care process between a nurse and another individual is a special, delicate gift to be cherished. The human care transactions provide a coming together and establishment of contact between persons; one’s mind-body-soul engages with another’s ­mind-body-soul in a lived moment. The shared moment of the present has the potential to transcend time and space and the physical, concrete world as we generally view it in the traditional nurse-patient relationship” (Watson, 1999, p. 47). Copyright © 2013. Springer Publishing Company. All rights reserved. Core and Trim In working with the philosophical, metaphysical aspects of caring in Watson’s theory, it is helpful to describe the microcosm of nursing practice using a core and trim model (Watson, 1979/1985). The constant core of nursing is conscious, deliberative caring, in all its forms and iterations. This core of genuine caring transcends space and time, similarly held as foundational by caring nurses in the 1800s and caring nurses in the 21st century. The trim is comprised of nursing knowledge, technologies, skills, and activities. The trim constantly changes to reflect the time/space/place/occasion in which caring moments occur, and will look drastically different in the 21st century as compared to the 1800s. The core and trim are both necessary to nursing practice. Neither the core nor trim could exist without the other. Here I use an ordinary orange to illustrate the concepts of core and trim. Envision an orange. The core, or edible inside of the orange, is the reason for the orange’s existence, just as caring is the reason for nursing’s existence. The orange’s juicy, sweet interior provides nourishment and sustenance, and the seeds contained within it guarantee the continuation of the species. In order for nursing to continue as a profession, the core of nursing (caring) must be recognized, valued, nurtured, and consumed/integrated. The 10 Caritas previously listed at the end of Chapter 2 comprise the inside of the orange (the core of nursing). The trim, the orange’s durable, fragrant, highly visible skin, represents the ever-changing activities of nursing. The trim is essential, as it surrounds and protects the core, allowing it to grow into maturity. The core and the trim work together in different capacities to support caring nursing practice. Trim without core is hollow, empty, and holds nothing of sustenance for survival, thus, without the core, the trim would dry up and wither away to dust. An orange can only exist when both core and trim are present. Sometimes in nursing, there is such a 34 Sitzman, K., & Watson, J. (2013). Caring science, mindful practice : implementing watson's human caring theory. Retrieved from http://ebookcentral.proquest.com Created from apollolib on 2018-09-27 08:03:41. 4. Entering the Stream: Understanding and Living Out Jean Watson’s Work strong focus on the trim, that the core is forgotten or trivialized, even though the core is the very reason for the trim’s existence. Envisioning core and trim as an orange is helpful in creating a mindful perspective related to caring as the reason for nursing’s existence. Allow miracles Loving kindness Basic needs Trim includes nursing care activities that change with time and specialty areas Authenticity Healing environment Sensitivity Transpersonal teaching Creative problem solving Love–trust– care Allow positive and negative Copyright © 2013. Springer Publishing Company. All rights reserved. Figure 4.2 Core and trim orange with Caritas. An orange meditation in the Thich Nhat Hanh mindfulness tradition is provided below to support mindful contemplation of nursing’s core and trim. Orange Meditation Hold an orange in the palm of your hand and look at it while breathing in and out, so that the orange becomes a reality. Try to be totally here, totally present, with the orange in your palm, dwelling in the present moment. See the orange tree, see the orange blossom, see the sun and the rain passing through, and see the tiny fruit form. And now the fruit has grown into a beautiful orange. Just looking and ­smiling into the orange will help you to get in touch with the wonders of life, and with the joy of caring. Sometimes it is easy to ignore the fact that the orange in the palm of your hand is a miracle, a wonder of life. There Sitzman, K., & Watson, J. (2013). Caring science, mindful practice : implementing watson's human caring theory. Retrieved from http://ebookcentral.proquest.com Created from apollolib on 2018-09-27 08:03:41. 35 I. Introduction to the Caritas and Enhancing Use through Mindfulness are so many wonders of life inside of you and around you. When you look deeply and smile at the orange in this way, it becomes possible to see the orange in its splendor, in its miraculous nature. And suddenly you also become a miracle and you are a miracle encountering another miracle. When you look at the orange deeply, you will be able to see many wonderful things: the sun shining and the rain falling on the orange tree, the orange blossoms, the tiny fruit appearing on the branch, the color of the fruit changing from green to yellow, and then the full-grown orange. Now slowly peel the orange. Smell the wonderful scent of the orange peel. Put a section of the orange in your mouth and taste the wonderful juice. The orange tree has taken three, four, or six months to make this orange for you. Now the orange is ready, and it says ‘I am here for you.’ If you are fully present, you will hear it, and the orange will be fully present also. Being fully present while eating an orange can be a deep and delightful experience. (Nhat Hanh, 2009, pp. 153–154) Becoming a Caritas Nurse: Value Assumptions of Caritas In the process of valuing, learning about, and translating Watson’s work in everyday nursing practice, it is necessary to cultivate understanding and internalize the foundational assumptions of this approach. The value assumptions are listed below (Watson, 1985, p. 32; Watson, 2008, pp. 41–42): • Caring and love are the most universal, tremendous, and mysterious Copyright © 2013. Springer Publishing Company. All rights reserved. cosmic forces; they comprise the primal and universal source of energy. • Often this wisdom is overlooked, or we forget, even though we know • • • • 36 people need each other in loving and caring ways. If our humanity is to survive and if we are to evolve toward a more loving, caring, deeply human and humane, moral community and civilization, we must sustain love and caring in our life, our work, and our world. Since nursing is a caring profession, its ability to sustain its caring ideals, ethics, and philosophy for professional practices will affect the human development of civilization and nursing’s mission in society. As a beginning, we have to learn how to offer caring, love, forgiveness, compassion, and mercy to ourselves before we can offer authentic caring and love to others. We have to treat ourselves with loving kindness and equanimity, gentleness and dignity before we can accept, respect, and care for others within a professional caring–healing model. Sitzman, K., & Watson, J. (2013). Caring science, mindful practice : implementing watson's human caring theory. Retrieved from http://ebookcentral.proquest.com Created from apollolib on 2018-09-27 08:03:41. 4. Entering the Stream: Understanding and Living Out Jean Watson’s Work • Nursing has always held a caring stance with respect to others and their health–illness concerns. • Knowledgeable, informed, ethical caring is the essence of professional nursing values, commitments, and competent actions; it is the most central and unifying source to sustain its covenant to society and ensure its survival. Preservation and advancement of caring science values, knowledge, t­heories, philosophies, ethics, and clinical practices, within a context of ­Caritas cosmology, are foundational for sustaining and advancing the discipline and profession. References Copyright © 2013. Springer Publishing Company. All rights reserved. Nhat Hanh, T. (2009). Happiness. Berkeley, CA: Parallax Press. Watson, J. (1979/1985). Nursing: The philosophy and science of caring. Niwot, CO: University Press of Colorado. Watson, J. (1999). Nursing: Human science and human care: A theory of nursing. New York, NY: National League for Nursing Press. Watson, J. (2008). Nursing: The philosophy and science of caring, revised edition. ­Boulder, CO: University Press of Colorado. Sitzman, K., & Watson, J. (2013). Caring science, mindful practice : implementing watson's human caring theory. Retrieved from http://ebookcentral.proquest.com Created from apollolib on 2018-09-27 08:03:41. 37 Copyright © 2013. Springer Publishing Company. All rights reserved. Sitzman, K., & Watson, J. (2013). Caring science, mindful practice : implementing watson's human caring theory. Retrieved from http://ebookcentral.proquest.com Created from apollolib on 2018-09-27 08:03:41.
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